SciDev.Net

Global health experts have watched with increasing alarm as the waistlines of people in developing countries have started to widen with the adoption of a "Western" lifestyle. Obesity is of such concern because of its heightened risks for other diseases, such as heart disease, cancer, and diabetes.

In developing countries, the number of people with diabetes is set to rise to 228 million by 2030 from 84 million estimated in 2000. The link between obesity and diabetes is so strong because obesity renders individuals unable to properly process glucose — about 90% of type 2 diabetes is due to being overweight. Obesity and diabetes also raise the risk for cardiovascular disease and kidney disease. Diabetic nephropathy was the most common cause of end-stage renal disease in 9 out of 10 Asian countries, say the authors, which could be deadly for countries unable to cope with the health repercussions.

This report is the WHO's official record of data produced by its technical programmes and regional offices in close consultation with countries and in collaboration with researchers and development agencies. The WHO produces the statistics to provide an evidence base for strategies to improve global public health.

The report clearly shows that the global burden of disease is shifting from infectious diseases to non-communicable diseases, with chronic conditions such as heart disease and stroke now being the chief causes of death globally. The shifting trends indicate that leading infectious diseases — diarrhoea, HIV, tuberculosis, neonatal infections and malaria — will become less important causes of death globally over the next 20 years.

The report documents in detail "the levels of mortality in children and adults, patterns of morbidity and burden of disease, prevalence of risk factors such as smoking and alcohol consumption, use of health care, availability of health care workers, and health care financing."

This joint publication between the World Health Organization and the Global Forum for Health Research reveals mental health research capacity in 114 low-income and middle-income countries in Africa, Asia, and Latin America and the Caribbean. The extensive review identified over 10,000 articles, 4,633 mental health researchers and 3,829 other stakeholders. The authors argue that this is "the first systematic attempt to confirm the pressing needs of improving research capacity in mental health".

The publication provides useful details in table and charts, analysed by group of stakeholders and by region, on topics such as: researchers' profiles; priority-setting process; amount and type of research production; services and technical support available to them; courses and trainings offered; funding patterns; and dissemination of research findings. The appendix provides two extensive lists — by country — of policy and practice that resulted from research evidence, as well as research evidence that was never translated into policy and practice.

Nine recommendations indicate how the management of mental health research can be strengthened so that it meets the national needs of the countries as well as contributes to the global fund of knowledge. The authors say their report thus enables evidence-based decision-making in funding and priority setting in the area of mental health research in low-income and middle-income countries.

These consist of two reports: SuRF1(Surveillance of risk factors related to non-communicable diseases: current status of global data) and SuRF2 (Surveillance of chronic disease risk factors: country-level data and comparable estimates).

These reports are the result of a large WHO project to set up for the first time a global database of the prevalence of risk factors for non-communicable diseases collected from WHO member states. The first report is largely a collection of the country profiles; the second analyses the data to produce comparable estimates for risk factor prevalence in the countries. The WHO designed this as an advocacy tool to highlight where primary prevention and health promotion need to be directed.

The eight risk factors were chosen because they are easily measurable and theoretically can be changed through prevention efforts. They are: tobacco and alcohol use, patterns of physical inactivity, low fruit/vegetable intake, obesity (as measured by BMI), blood pressure, cholesterol and diabetes (measured by blood glucose).

The second report presents country-level estimates for overweight/obesity and systolic blood pressure. It also shows the attributable mortality and disease burden from all causes of death due to these overweight and high blood pressure for the 11 most populated countries. 

(See WHO Global InfoBase Online for electronically searchable data contained in the reports http://www.who.int/infobase/surf2/online.html.)

This series of five articles outlines new challenges and unsolved problems since the journal's last series in 2005. The first article ([189kB]) predicts the disease burden and economic losses that developing countries would face from chronic diseases such as cardiovascular disease, cancer, chronic respiratory disease, and diabetes. In the 23 countries that the authors incorporated into a model, chronic disease was responsible for 50% of the disease burden in 2005. If no action is taken, they say, about US$84 billion of economic production will be lost from heart disease, stroke, and diabetes alone in these 23 countries between 2006 and 2015. The second article ([105kB]) looks at how to scale-up strategies to fight chronic diseases in developing countries. The authors review evidence to identify which methods are cost-effective and financially feasible, and therefore ready to be scaled-up.

Tobacco control, salt reduction (both of which are detailed in the series' third paper ([177kB])), and a multidrug strategy to treat individuals with high-risk cardiovascular disease (see an in-depth look in paper four ([220kB])) are prime candidates for scaling-up. What effect improving health systems has on the level of chronic diseases should be properly evaluated, say the authors. For some health interventions, such as preventing or controlling diabetes, there is little cost-effectiveness data for low or middle-income countries, but their scientific effectiveness is so compelling that countries should consider how best to incorporate them. The final paper ([92kB]) is a call to action to incorporate existing interventions into healthcare programmes, which in 2005 was costed at US$5.8 billion.

1990 saw the first major effort to estimate the main causes of illness and the biggest killer diseases in different countries. The data are important for public-health officials to allocate their resources wisely but also for feeding into estimates to plan for the future. Importantly, these need to be regularly updated to ensure that health programmes are still going in the right direction. This paper updates the 1990 study and offer predictions up to 2030.

The most forceful change in disease trends is in developing countries, with the proportion of people affected by non-communicable diseases set to increase. Proportionally, the number of people with infectious diseases is set to fall, though not when it comes to HIV/AIDS.

Because the authors also rely on predicting socio-economic development trends, they created best-case and worst-case scenarios for economic growth. In the pessimistic scenario, by 2030, the three leading causes of illness will be HIV/AIDS, depression, and ischaemic heart disease; in the optimistic scenario, road-traffic accidents will replace heart disease as the third leading cause.

The WHO has provided its own estimates of how non-communicable diseases are set to rise in developing countries. These authors pool data from national registries and international databases to compare data on the differing burden from individual diseases. They outline the risk factors associated with the diseases.

The main three killers are cardiovascular disease, diabetes, and cancer. The paper ranks different types of cancer by how many people in developing countries they kill (lung and breast cancer are the deadliest) and also ranks diabetes prevalence by country (India, followed by China, has the highest prevalence).

To tackle these diseases, say the authors, people need to look closely at the risk factors in their life – eating healthily and exercising can do much to reduce the chances of getting one of these diseases.

Cardiovascular diseases are set to rise dramatically in developing countries, partly because of an increase in risk factors for the diseases, which include diet, physical activity, smoking. The authors looked at cardiovascular disease risks such as being overweight or obese, systolic blood pressure, and total cholesterol, and related them to national income, food purchase constraints, and urbanisation. Body mass index (BMI) and cholesterol increased as national income increased, then flattened, and eventually declined. BMI also rose with increasing urbanisation.

The authors suggest that cardiovascular disease risks will increasingly be concentrated in low-income and middle-income countries. Thus, preventing obesity should be considered a priority in these countries, along with measures to control blood pressure, cholesterol, and tobacco use.

Chronic diseases — heart and lung disease, cancer and diabetes — are having a negative economic impact on both the developed and developing world, says this report, which is why they should be properly addressed by domestic and international policy makers. Compared to the epidemiological evidence on the rise of non-communicable diseases in developing nations, there is little information on how this increase will affect their economies.

This report investigates the demographics of the problem and finds that contrary to popular belief, the disproportionate burden of disease on the elderly does have economic implications. The reason is that though the elderly may not be part of the workforce, they are still consumers and therefore a part of the economic equation.

Whether approaches to tackling chronic diseases are cost-effective or not is a vital issue for countries whose health budgets are already overstretched — the report outlines some of the interventions that offer most bang for buck. The authors point out that strategies that work well in developed countries are not so effective in developing countries, and call for more research to assess what will be appropriate.

This extensive report was one of the first to document the scale of the problem of chronic diseases in developing countries, and crucially, to offer guidance on feasible and practical methods of tackling them.

The document starts by laying out in detail the profiles of chronic diseases in different countries, projections for the future, and how chronic diseases are linked with poverty. It also examines in depth the economic costs of such diseases and the macroeconomic consequences of not tackling them quickly enough. The authors outline interventions — whether community, workplace, or school — that have robust evidence supporting them.

The report ends with a call for a unifying framework of global health experts and stakeholders, in which the government has a key role. It also specifies what policymakers need to do to ensure that measures to tackle chronic diseases are put into action.

This document presents the proceedings of a conference at the Royal Netherlands Academy of Arts and Sciences in December 2001. The conference papers deal with themes relating to the role of scientific research in the development of Northern countries and the need for North–South research cooperation. They document the experiences of research cooperation involving, among others, India, South Africa and a number of East African countries. Several papers deal with innovation and scientific cooperation, with case studies.

The report summarises the results of a survey of African Universities’ experiences in collaborating with scientists and institutions in developed countries. The study was carried out by the Association of Commonwealth Universities to provide background information to support the recent development thrust aimed at strengthening African universities through greater investment and North–South (and South–South) collaboration. It focuses primarily on social sciences and humanities research. The report presents empirical data on institutional goals, resource availability, prevalence and satisfaction with collaborative arrangements, challenges faced by individual researchers, capacity building as well as training and research support.

This paper presents a review of the challenges of international scholarly scientific collaboration. It looks at institutional constraints and points out that the challenges and problems multiply when collaborators come from different countries with differing conditions, resource endowments and institutional structures. It is easier to call for more and better forms of international collaboration than it is to design them. The report asserts that good design is helped by a better understanding of what collaboration is and how it has been carried out. It draws on social research insights to help reduce the transactional, financial, ethical and emotional costs of international linkages and exchange and provides a conceptual framework for thinking about international collaboration issues.

This draft policy brief says African, Caribbean and Pacific (ACP) countries can use local natural resources — such as sugarcane and jatropha — to meet energy requirements through biofuels, curtailing dependence on fossil fuels.

But the authors warn of challenges for developing countries, including economic and trade issues, and suggest practical steps for meeting these. They also present various bioenergy options for households, such as BioGel — a solid wood-substitute made from low-grade ethanol mixed with a gelling agent.

The brief makes a number of policy recommendations, including national strategies for promoting and sustaining local demand, and more funding for local and regional ACP research.

This chapter of the IPCC special report on climate change's regional impacts is one of the most authoritative sources on the issue, despite a considerable amount of work having been published since.

The chapter covers the regional climate, key vulnerabilities for various sectors, such as terrestrial ecosystems, water resources, agriculture and fisheries, coastal zones, human settlements and health. A synthesis outlines the potential impacts on the continent and lays out the key challenges that should guide further research.

This chapter should be read together with chapter 10 of the IPCC's 'Climate Change 2001' report. They cover similar ground, but various developments in research distinguish the two. The document is also available in French (PDF).

In recent years, case studies of countries' experiences of adapting to the impacts of climate change have begun to emerge. This paper is a summary of a presentation given at the 2006 UN Framework Convention on Climate Change African Workshop on Adaptation and outlines adaptation planning experiences from Tanzania.

After background information and a summary of environmental stresses and the regulatory context in Tanzania, the paper outlines in detail the types of adaptation strategies the country is implementing. 

The paper highlights that many adjustments are necessary at an international, national and local level. Adaptation to climate change, the authors demonstrate, can mean anything from fortifying early warning systems and regulating water rights to using local seed varieties for their drought-resistant characteristics.

The brief provides an accessible and hands-on summary of adaptation activities in Tanzania and should be useful to practitioners in developing and developed countries alike.

This chapter of the Third Assessment Report of the Intergovernmental Panel on Climate Change is the authoritative source on climate change impacts and vulnerabilities in Africa. It summarises much of the peer-reviewed literature that explains how Africa will fare in a changing climate.

Background information on why Africa is particularly vulnerable to the impacts of climate change is provided. The major issues of regional concern including unreliable water resources, food security, natural resource management and loss of biodiversity, human health, the built environment and infrastructure and desertification and how these will be compounded by projected climate change are discussed.

The chapter highlights the uncertainty of predicting climate change impacts in Africa and emphasises the existing diversity of African climates.

The provided synthesis of years of peer-reviewed research is essential reading for anyone interested in climate change in Africa. The text is also available as an html document.

This paper provides a call for a new Green Revolution focused on Africa. It summarises the successes and failures of the original Green Revolution, setting out the challenge of igniting a new one that can succeed in Africa.

The authors identify the need for more robust seed varieties, more trained scientists, improved inputs and cultivation practices, better supply and marketing infrastructure, and greater access to irrigation. Achieving these, say the authors, will require strong partnerships between philanthropists, governments, donors, research institutes and the private sector, as well as decisive leadership.

This scientific article provides an insight into the status of public research in genetically modified (GM) crops in Egypt, Kenya, South Africa and Zimbabwe in 2004.

The authors document 54 transgenic 'events' — specific instances of genetic transformation — across the four countries. They identify work to develop GM strains for 20 crops, including cotton, maize, potatoes, sugar cane, tomatoes and wheat. South Africa is shown to be a particularly important centre for biotech research, accounting for 28 out of the 54 events examined.

The authors call for a simplified system to facilitate regulatory approval of GM crop trials and commercial releases across the continent as a whole and suggest measures to encourage inter-institutional links and South–South collaborations.

This research article, by Rosemary Wolson at the University of Cape Town, assesses South Africa's biotechnology policies, reviewing three major initiatives — the national research and development strategy, biotechnology strategy and proposed laws to govern intellectual property rights derived from publicly funded research. Wolson explains the origins, goals and implementation of each.

The projects aim to create a coordinated strategy for promoting biotechnology in South Africa. Wolson concludes that the efforts are an encouraging sign of governmental commitment, but notes the continuing challenge of integrating the individual projects into a coherent framework. This may depend on promoting social networks to catalyse innovative industries.

She calls for the government to encourage more private enterprise and investment while remaining committed to basic research.

This article is useful to anyone hoping to understand the policy framework for biotechnology in one of sub-Saharan Africa's key scientific and industrial powers.